Contact-Force-Sensing-Based Radiofrequency Catheter Ablation in Paroxysmal Supraventricular Tachycardias (COBRA-PATH): a randomized controlled trial

Tamas Geczy, Nawin L Ramdat Misier, Tamas Szili-Torok, Tamas Geczy, Nawin L Ramdat Misier, Tamas Szili-Torok

Abstract

Background: Multiple studies have demonstrated the importance of adequate catheter-tissue contact in the creation of effective lesions during radiofrequency catheter ablation. The development of contact force (CF)-sensing catheters has contributed significantly to improve clinical outcomes in atrial fibrillation. However, CF-sensing technology is not used in the ablation of paroxysmal supraventricular tachycardia (PSVT). The possible reason for this is that PSVT ablation with the conventional approach (i.e. nonirrigated, non-CF-sensing catheters) is considered a relatively low-risk procedure with fairly high success rates (short and long term). The aim of this study is to determine whether CF sensing can further improve the outcomes of PSVT ablation.

Methods/design: The COBRA-PATH study is a single-center, two-armed, randomized controlled trial. Patients without structural heart disease being referred for electrophysiology study, because of PSVT and potential treatment with radiofrequency (RF) catheter ablation, will be randomly assigned to either manual ablation with standard nonirrigated ablation catheters or manual ablation with an open-irrigated ablation catheter equipped with CF sensing (used in a virtual nonirrigated modus). The primary study endpoint is the difference in the number of RF applications during the ablation of atrioventricular nodal re-entry tachycardia, and that of Wolff-Parkinson-White syndrome and atrioventricular re-entrant tachycardia. Secondary outcome parameters include acute and long-term procedural success rates, overall duration of RF applications, procedure/fluoroscopy durations and safety parameters.

Discussion: We expect to see a reduced number/duration of RF applications required to achieve effective lesion creation, and consequently a decrease in total procedure/fluoroscopy times. Although a significant improvement in procedural success rates (acute/long term) might not be feasible to demonstrate (given the relatively high success rate of the standard ablation method), the possible decrease in procedure duration and the consequential reduction of radiation exposure has important clinical implications for both operators and patients undergoing the procedure.

Trial registration: ClinicalTrials, NCT04078685. Retrospectively registered on 2 September 2019.

Keywords: Ablation; Contact force sensing; Supraventricular tachycardia.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Contact-Force-Sensing-Based Radiofrequency Catheter Ablation in Paroxysmal Supraventricular Tachycardias (COBRA-PATH) study flow chart. *Symptoms highly suggestive of PSVT: sudden onset of termination of rapid (and regular) palpitations. The palpitations can usually be terminated with the Valsalva maneuver or carotid massage. The patients have no evidence for an underlying structural heart disease. #For a detailed explanation, see “Study population”. $For a detailed explanation, see “Preprocedural preparation and electrophysiology (EP) study”. &This follow-up can be scheduled any time during the 12-month follow-up period, in case the patient experiences recurrent symptoms (symptom-based follow-up). AE adverse event, AVNRT atrioventricular nodal re-entry tachycardia, CF contact force, FU follow-up, I/E inclusion/exclusion, PVST paroxysmal supraventricular tachycardia, SAE serious adverse event, WPW-AVRT Wolff–Parkinson–White syndrome–atrioventricular re-entrant tachycardia

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